1.0 EXECUTIVE SUMMARY

1.1 INTRODUCTION

Management of Anglican Diocesan Development and Relief Organization (ADDRO) presents Annual programme report for January to December, 2016. The report provides an overall update of ADDRO’s programmes and projects within the 2016 fiscal year. It highlights progress of activities implemented, key results achieved, challenges as well as lessons learned during the period from January 2016 to December, 2016.

In 2016, ADDRO focused on two broad programmes namely the Integrated Community-based Health Program (ICBHP) and the Food Security & Livelihood Improvement Program (FSLIP).

1.2 PROGRAM IMPACTS IN 2016

1.2.1 FOOD SECURITY AND LIVELIHOOD IMPROVEMENT PROGRAM

Ghana has over the past decades made some impressive strides in the fight against poverty; but the three northern regions continue to experience significantly high levels of poverty (GSS, 2014). The concentration of poverty in these regions gives rise to food insecurity and poor livelihoods. It is the desire to address the endemic food insecurity, malnutrition and precarious livelihood outcomes occasioned by high incidence of poverty that the Anglican Diocesan Development and Relief Organization (ADDRO) with funding from the Episcopal Relief and Development has been implementing a food security and livelihood support programme in the Upper East Region of Ghana since 2006.

The Food Security and Livelihood Improvement Program seeks to address the following objectives:

To increase household agricultural production and productivity by 40% by 2019

To improve household food security through agro-processing and storage.

To increase micro-entrepreneurs access to financial services by 40% to promote Small and Medium Enterprises (SMEs) by 2017.

The program is progressively making strides towards attainment of the program goal and objectives. The following achievements were made within the year.

A total of 125 new farmers comprising 56 males and 69 females joined the program this year and acquired relevant knowledge and skills in Good Agricultural Practices in the areas of farm planning, land preparation, planting, fertilizer application and weed control. This brings the total number of crop farmers under the program to 1,085 comprising of 611 males and 474 females

Another 123 new farmers comprising of 2 male and 118 females also received breeding stock of sheep and goats in addition to capacity building in improved livestock husbandry practices to go into livestock production as income generation businesses. This also increased the number of livestock farmers on the program to 560 (77 males and 483 females).

A total of 102 micro entrepreneurs comprising 83 females and 19 males also received training in business management and 85 (10 males and 75 females) received credit to engage in income generation activities.

This year, 47 Savings with Education groups comprising a total of 816 members were formed and trained. The groups have made a cumulative savings of GHS 28,241.00 by the end of December, 2016.

1.2.2 INTEGRATED COMMUNITY BASED HEALTH PROGRAM (ICBHP)

ADDRO’s Integrated Community Based Health Program (ICBHP) was started in 2006. ICBHP is an Integrated Community-based Program which contributes to the improvement of maternal and child health. The program uses the integrated Community Case management (iCCM) and Social and Behaviour Change Communication (SBCC) strategies with its focus on malaria, diarrhoea, and pneumonia among children under five years, pregnant women and women of reproductive ages. As part of the program, ADDRO partners with National Malaria Control Program (NMCP) and other partners to carry out Maternal and Child Health (MCH) activities at the community level.

The goal of ADDRO’s MCH is to contribute to the reduction of communicable diseases including; malaria, pneumonia, and diarrhoea in children under five years using iCCM strategies and also to improve maternal health especially in pregnant women. Specifically, the program seeks to address two objectives:

Increase access to and use of quality health care in rural areas for mothers, children, and their families.

The MCH program operates in six (6) regions but seven (7) sub- Districts in Ghana. The operational regions and districts are as follows: Bawku West and Builsa North in Upper East region, Karaga in the Northern region, Nadowli in the Upper West region, Bosome Freho in the Ashanti region, Akwapim South in the Eastern region and Sefwi Wiawso in the Western region of Ghana.

The program has chalked a number of successes in 2016. Among others, key achievements within the period include the following:

Nine (9) ADDRO staff and 21 staff from GHS benefitted from a training of Trainers (ToT) workshop on social and behaviour change communication (SBCC). This training empowered them with effective training skills that enabled them to design and deliver effective SBCC cascade trainings of CBAs at the community levels.

Cascade SBCC trainings of CBAs were organised in each of the seven sub districts under ADDRO’s ICCM program. A total of 228 CBAs made up of 116 male and 112 females received the training.

ICCM medicines were procured by ADDRO and distributed to all seven sub districts.

Within the period under review, 95 community sensitization sessions (durbars) were organized for community members by all ADDRO Regional Coordinators. In all, 8,559 community members comprising 3,477 males and 5,082 females participated. These resulted in increased mothers / primary caregivers’ knowledge and practice of key behaviours in health promotion, disease prevention, appropriate home care, and healthcare seeking for malaria, diarrhoea, and pneumonia.

All Regional Coordinators facilitated the entry of iCCM data collected from CBAs into District Health Management Information system (DHMIS). The DHMIS is a software that supports the capture of data linked to any level in health sector.

On HIV/AIDS, ADDRO worked within the religious structures (churches and mosques) to ensure a reduction of new infections in various communities.

The project aims to ensure increases in the uptake of HIV Testing and counselling (HTC) through religious congregations and mobile outreaches among others. Working at reducing stigma has the potential of reducing the spread of HIV and mortality due to HIV.

Specifically, the project addresses the following objectives:

To promote safer sexual practices among 30 religious congregations in three Districts in the Upper East Region by the end of June, 2016

To promote the uptake of HIV testing and counselling services among 30 religious congregations in three Districts by the end of June 2016

To sensitize18,900 youth and adults among 30 congregation in three districts on HIV/AIDs stigma reduction and discrimination practices against PLHIV by end of June 2016

The support of peer educators among other groups in HIV/AIDS outreach and clinical activities has contributed to reduce the negative effects of stigma and promoted healthy sex behaviours, thereby creating hope among the populace.

1.3 GENERAL ISSUES

Programme Development and Staffing issues

Early this year, ADDRO entered into partnership with a UK-based donor known as Against Malaria Foundation (AMF). This year, AMF supported ADDRO and National Malaria Control Program (NMCP) to distribute 2,686,808 LLINs in the Northern, Upper West and Greater Accra regions. Under this project, ADDRO and Episcopal Relief & Development will carry out monitoring of campaign activities and Post-Distribution Check-Ups (PDCU) of these LLINs in 43 districts across these three regions for a period of two and a half years.

ADDRO in partnership with Ghana Health Service (GHS) supervised the distribution of LLINs in Upper East Region. In all, 617,000 LLINs were distributed to beneficiaries in the region. The Upper East LLINs was however not part of the AMF support.

ADDRO has established a regional office in Accra for the Greater Accra team.

On the AMF project, ADDRO recruited eight new staff to join the existing regional coordinators and HQ Team to implement the programme in the afore-mentioned three regions.

The BCC officer, Ebenezer Ndebilla was also elevated to join the management team as the Food Security and Livelihood Program Coordinator to fill the vacuum created by Emmanuel Tia Nabila, who exited from the organization.

David Akurikiya has been recruited as project officer on the FSLP to replace John Manyeyii who passed away in March this year.

Ayariga Samson Austin was also recruited to support the FSLP team on Binaba as Juliana Awini is relocated to Zebilla in the Bawku West District.

Over 60 data entry clerks have been recruited on temporary basis to enter all data in the AMF supported project.

OUR DONORS / PARTNERS HAPPY WITH OUR WORK

Fig 1 ADDRO staff with Pilgrims

During the first quarter, ADDRO was privileged to be visited by pilgrims (18th to 21st January 2016) accompanied by Ms. Vesta Oduro-Kwarteng, a staff of Episcopal Relief & Development, Accra.

The pilgrims were very excited about our programmes as they visited the following project sites:

Anglican Women Development Centre (ANWOC) where a durbar was held, they interacted with shea butter and groundnuts processors.

Azongi community where they observed CBAs giving health education on Malaria, diarrhoea and pneumonia as well as treatment. They also observed LLINs hanged in the rooms and interacted with beneficiaries.

Teshie centre where persons with disabilities have carpentry workshop for woodwork.

Sumbrungu to observe women in basketry work, where these women weave baskets and other art works.

Kalbeo to observe our micro credit beneficiary groups in processing of groundnuts and rice, and weaving of traditional cloths.

Sirigu community, where they interacted with basket weavers.

Binaba community, where they had a short church service, observed processing equipment such as grinding mill, rice and shea butter processors, and interacted with women beneficiaries of ruminants and the donkey project.

Overall, the implementation and outcomes of the ADDRO programs within the period have been very impressive. I would like to take this opportunity to congratulate and thank all ADDRO staff for their relentless efforts in spite of diverse challenges.

I also wish to register my profound gratitude to the Board of Directors, partners and donors of ADDRO without whom it would not have been easy for ADDRO to go this far on our way to realizing the goals of the organisation. On behalf of our program beneficiaries and communities, I thank you all very much for your contribution in making a difference in their lives.

Wishing you merry Christmas and a Prosperous New Year in advance!

With kind regards and prayer.

Rt. Rev. Dr. Jacob Ayeebo

Executive Director.

December, 2016.

2. 0 DETAILED REPORTS

2.1 FOOD SECURITY AND LIVELIHOOD SUPPORT PROGRAMME

2.1.1 INTRODUCTION

The Food Security and Livelihood Support Program (FSLP) is one of the two main programs of ADDRO funded by the Episcopal Relief and Development (ERD) based in the United States of America (USA). The goal of the program is to contribute to the eradication of extreme poverty and hunger, in alignment with Millennium Development Goal One (MDG 1). In achieving this goal, the program will further contribute to the attainment of two (2) of the Millennium Development Goals (MDGs) which include: to promote gender equality and empower women (Goal 3), and ensure environmental sustainability (Goal 7). The specific objectives of the program are to:

Improve small and medium businesses by providing support to entrepreneurs.

2.1.2 Food Security Program Activities Implemented in 2016

The activities carried out within the period include; Support 200 farmers with improved seed varieties of maize, conduct participatory workshops on improved farming and tillage practices, demonstrate improved farming practices (Integrated Crop and Pest Management) using farmer Field Schools, conduct monitoring of project activities, empower 120 farmers with improved breeding stock of goats & sheep, train 120 farmers in improved husbandry practices (including simple medication and watering), support women to establish pig farms as income generating project, provide essential veterinary drugs, vaccines and supplies for vaccination and treatment of project livestock, train 20 Community Extension Volunteers to support technology transfer in their communities, provide incentives for Community Extension Volunteers (Wellington boots, Protective Clothing, etc.), Support 30 women with shea-nuts to process into shea-butter and sell to increase their income levels, support 30 women with paddy rice to process for sale, train entrepreneurs in credit and business management and record keeping, facilitate the establishment and development of entrepreneurial groups, and provide micro-credit to entrepreneurs to engage in income-generating ventures (new clients).

All planned activities for the quarter have been successfully carried out, notwithstanding the fact that there were a few challenges. Some of the challenges encountered during the period include; the delay in the release of funds by Episcopal Relief and Development resulting in pressure on programme staff in activity implementation and continuous rainfall within the period that affected the attendance of programme meetings by participants.

2.1.3 Program planning meeting

A meeting of all food security programme staff was held in Bolgatanga on the 8th February, 2016. The purpose of the meeting was to look at the detailed programme activities for 2016 and to share programme targets to the four programme locations/centres namely Sherigu Anglican Women Development Centre, (SAWDC), Anglican Women Development Centre, (ANWOC), Binaba Area Community Health programme centre (BACH) and Bongo Community Based Rehabilitation project. The meeting also enabled programme Officers who participated in the planning meeting in Accra to discuss and share with field staff the decision taken during the Accra meeting especially the savings with Education programme.

2.1.4 Training of facilitators and supervisors on saving with Education (SwE)

In order to effectively commence the Savings with Education programme, Facilitators and supervisors were trained. The training took place from the 9th to 12th February, 2016 at the Extee Crystal Hotel, Bolgatanga. The training was facilitated by Kellie McDaniel and Priscilla Amuah, all staff of Episcopal Relief & Development. Thirteen (13) staff of ADDRO benefitted from the training. The key components of the training were the introduction to savings with education, the formation of savings groups, rules and regulations governing saving groups, the formation of management committees of saving groups and the roles of each management committee member etc. The workshop was practically oriented as it entailed group presentations at each stage. Participants were at each stage put into groups to perform a task and make presentations to the house. The training manual along with necessary forms and tools were shared with participants.

The program which was initially planned to kick start stalled due to non-availability of funds

2.1.5 Community Mobilization/ promotion meetings on saving with Education

During the period under review, field officers organized participating communities and introduced to them the concept of saving with Education. Field officers gave a brief introduction to saving with education, its benefits to members of the groups and how groups could be formed and managed. Savings with Education is a method of saving where interested community members are guided to form groups of 20-25 members each, elect their leaders, set rules to guide them and save regularly into a cashbox at each meeting day. Saving group members can decide to give loans to members form their savings or wait until their savings mature at a specified date and the money shared among themselves. Thirty-five saving groups have so far been formed and training meetings soon to commence.

2.1.6 Capacity Building for ADDRO Staff

In order to enrich the capacities of the staff working on the food security program, a four-day capacity training workshop on Good Agricultural Practices (GAP), small ruminant management and micro-credit management were organized for the program staff from the 26th-29th April, 2016. The training was a trainer of trainers workshop aimed at equipping program staff with the requisite knowledge on the above topics to enable them provide similar trainings to the program beneficiaries at the community level. However, the training of program beneficiaries will be conducted in collaboration with the Ministry of Food and Agriculture extension officers at ADDRO operational districts. In all, nine (9) program staff benefitted from the training.

2.1.7 Workshops on improved farming and tillage practices

During the period under review, participating beneficiaries selected to benefit from the input support programme were trained on good agricultural practices to equip them with the necessary skills and knowledge on maize production to enable them use the input support effectively. These trainings were participatory by nature and facilitators employed practical demonstrations to make the trainings lively. Some of the good practices include weeding, spacing, fertilizer application, integrated pest management, contouring, composting etc. In all, two hundred (200) beneficiary farmers were trained comprising 103 males and 97 females. For instance, the farmers were admonished to plough across the path of water or across slopes to prevent erosion from washing away the soil nutrients. In fertilizer application, farmers were taken through how to apply and when to apply. They were taught that the appropriate fertilizer to use as basal application is the NPK and that should be done two (2) weeks after shooting, and that when applying the fertilizer, a hand full of fertilizer should be applied to five (5) holes in a bed and not more or less to provide the necessary amount of nutrients needed for growth.

They were also educated that SA (Nitrogen Base Fertilizer) is the best fertilizer used for the second application and that, it is done six (6) weeks after planting. The facilitator advised the farmers to bore holes close to the crop, apply the fertilizer and burry it. The reason is to avoid the fertilizer from evaporating or being washed away by a heavy rainfall immediately after application.

Farmers were also advised not to farm close to river banks because any time the river overflows, the farm lands will be flooded and can wash away their crops and that can lead to farmers losing their crops and farm lands.

The workshops offered farmers the opportunity to also share experiences on the methods of farming they have been practicing over the years which do not give them good yield and expressed happiness in the new farming methods that they had learnt and hoped it will help improve on their yield this farming season.

Fig 2 Field officer doing practical demonstration during GAP training

2.1.8 Support 200 farmers with improved seed varieties of maize and soya bean

The period witnessed the distribution of maize seed and chemical fertilizer to two hundred (200) participating farmers for the 2016 farming season. These were made up of 103 males and 97 females. Each beneficiary was supported to cultivate an acre of land by providing them with 9kg of maize seed and 3 bags of chemical fertilizer per acre of farmland.

After sensitizing beneficiary communities on the intervention, many applications were received and screened; and subsequently 120 farmers selected to benefit from the intervention. The beneficiaries were later trained by government Veterinary service officers with support from ADDRO program staff on improved husbandry practices such as proper housing, feeding and identification of animal diseases and treatment. On housing, participants were told that the proper housing units should possess the following features: proper and adequate space for the animals, should prevent animals from adverse weather condition such as extreme cold or heat and serve as security, contain windows and doors for ventilation situating on well drain soil with floor ramped and wall plastered and roofed, regular cleaning, feeding and watering.

Good feed, according to the facilitator, promotes animal growth and health. Feed should contain protein, carbohydrate and minerals to enhance development in the animals. They were advised to provide supplementary feeding especially during the dry season, and to try as much as possible to prevent their animals from the adverse condition of whether such as rain from beating their animals. He also added that farmers should try as much as possible to isolate pregnant ones and feed them adequately.

In all, 120 women who were selected to benefit from the animal support were trained and supported with either goats or sheep based on individual request. Two animals were given to a woman to rear and after two years, two offspring would be recovered and passed on to new beneficiaries. To ensure the beneficiaries are given healthy ruminants, all animals purchased or recovered for distribution to beneficiaries were vaccinated against the common diseases that affect small ruminants before passing on to the beneficiaries. Overall, the total number of animals distributed to beneficiaries were two hundred and forty (240).

After training the selected women on improved husbandry practices, each received two (2) small ruminants for rearing. The ruminants were either goats or sheep depending on the request made by beneficiaries. In presenting the animals to the women, project officers admonished beneficiaries to take good care of the animals so that they can repay the two offsprings two years later and still have enough to sell and cater for their personal needs.

Fig 3 Small ruminants ready to be distributed to beneficiaries

Support women to establish pig farms as income generating projects

The programme supported six women to establish piggeries as income generating projects to support themselves. Each woman was provided with two pigs and supported to construct housing units to house them. The purpose was to empower them economically through the rearing of the pigs as they can generate income from the sale of the pigs which are high breeding animals. It was also to attract other pig farmers in the communities to build similar houses for their pigs instead of rearing them in free range.

However, to ensure proper care for the pigs, beneficiary pig farmers were trained on improved care of pigs. The topics treated include; housing of pigs, feeding, and identification and treatment of pigs. On housing, farmers were admonished to provide enough ventilation since pigs do not strive well in heat

ADDRO in collaboration with the Veterinary Services officers went round to vaccinate small ruminants of old beneficiaries that have been supported by ADDRO against common diseases in all programme communities. This practice is to ensure that the animals are healthy at all times and also to improve good breeding.

Train 20 Community Extension Volunteers to support technology transfer in their communities

Volunteers who play pivotal role in the implementation of the food security project were selected by community members to support programme staff to mobilize communities and beneficiaries for activity implementations. The criteria for selecting a community volunteer was that, a volunteer should be willing do the work free of charge and residing in the community. A volunteer is expected to possess some qualities including; being an honest and trustworthy person, easily approachable and reliable.

The volunteers were taken through good agricultural practices for maize production, rearing of small ruminants and business management. On the good practices for maize, they were taken through the best ploughing methods, planting, weed control methods, and fertilizer application. They were as well taken through how to identify diseases in animals and refer quickly to the veterinary officers for prompt action. They were taught to assist farmers built housing units that are well ventilated enough to house their animals. On business management, they were taken through record keeping to enable support micro entrepreneurs take proper records of their businesses.

In all, twenty (20), community extension volunteers comprising 17 males and 3 females were selected and trained to support the implementation of programme activities. These volunteers were provided with incentives such as bicycles, programme branded T-shirts, wellington boots, bags, rain coats and others to enhance their work in the field.

Provide incentives for Community Extension Volunteers

As part of measures to motivate community extension volunteers to give up their best in supporting the farmers, the programme provided some incentives to the volunteers. They were provided with incentives such as bicycle tires and tubes to replace worn-out ones on the programme provided bicycles, wellington booths, and rain coats. These items are meant to facilitate the work of the community extension volunteers. In all, sixty (60) old community extension volunteers were provided with the above incentives to facilitate their work

Support 60 women with shea-nuts and paddy rice to process into shea-butter and rice respectively and sell to increase their income levels

In contributing to empowering women economically, sixty (60) women were supported with cash amounts to enable them purchase shea-nuts and paddy rice to process into shea-butter. The essence of this intervention is to support women to acquire a trade by adding value to the sheanuts and earning high incomes, thus, making them economically independent.

However, these support to the women processors were preceded by training sessions to provide the women processors with the necessary skills to be able to operate profitably. The participants were taken through basic hygiene in food processing, packaging, storage, and marketing of their products to prospective buyers. Participants were admonished to practice good hygiene and proper packaging of their products to make more profits.

Fig 4 Women processors undergoing training

Train entrepreneurs in credit and business management and record keeping

Micro-credit beneficiaries who were selected to benefit from the 2016 micro-credit support from the programme were trained on credit and business management before the disbursement of the credit facility to them. The entrepreneurs comprised of 10 males and 75 females. Micro entrepreneurs were taken through the credit policy of the organization, customer care relationship and how to keep proper records of their businesses. They were admonished to take records of all transactions very seriously as it will help them determine whether they are making profit or losses. Proper record keeping could also help them obtain more financial support from other financial institutions to expand their businesses.

After successfully undergoing credit and business management training, micro-entrepreneurs were given cash loans ranging from GHS200.00 to GHS1,000.00 depending on the assessment made on the client’s ability to repay loan by the loans committee. Though, the programme initially planned to support 60 beneficiaries, it managed to increase the number of beneficiaries to 85 due to the large number of request received from interested groups.

To further engage farmers to put into practice the knowledge acquired during the training on good agricultural practices, four maize demonstration farms were set up by ADDRO in some of the programme operational communities. Two were set up at Gbere-Kpalsako and Zuayanga communities under the Anglican Women Development Centre (ANWOC), one at the Binaba Area Community Health Project (BACH) at Kansoogo community and one at the Sherigu Anglican Women Development Centre (SAWDC) at Yindure community. At these farms, the farmers were guided by Agricultural Extension Officers and Programme staff to practically grow maize applying the good agricultural practice methods learnt and also using their traditional methods of farming to enable them appreciate the knowledge acquired. Thus, an acre of land is acquired and divided into two equal parts. One half of the farm is used to implement the good agricultural practices learnt and the other half used to implement the normal farmers’ practice. They were taken through the various stages of cultivation; good maize planting methods, proper fertilizer application and weed control methods. The purpose was to see which practice will produce the highest yield. Harvesting of the demonstration farms are scheduled to take place in October 2016.

Fig 6 Farmers during sowing and fertilizer application on a demonstration farm

Conduct of mid-term review meeting

During the period under review, a programme meeting comprising all programme field staff, Monitoring and Evaluation Officer and Programme Coordinator was held to review the activities implemented, share experiences and find possible solutions to challenges encountered within the period. Field staff shared experiences with each on the activities of programme participants. For instance, some cash loan beneficiaries owed some project centers and tried applying at a different project centre for another loan but the officer was suspicious and contacted her colleague to verify and realized she defaulted in repayment in her previous loan, thus was disqualified. They therefore called for close collaboration and networking in the implementation of their daily activities.

In this meeting, field staff revealed that the period has been hectic and tiresome since they had to implement both period one and two activities within period two due to late receipt of funds

Donkey set financing project

Two separate meetings were held with donkey set beneficiaries in Bongo and Bawku West to determine the challenges confronting beneficiaries in the repayment of their loan facility and together with the beneficiaries find solutions to them to enable them repay their loans. It was found out that their major challenge was that the repayment period was short. Thus, it was agreed that the loan repayment period be rescheduled to another 12 months to afford them more time to repay. This has since been communicated to all beneficiaries and they are satisfied with the new arrangement. However, some beneficiaries reported of their donkeys stolen whiles some are reported dead. A decision is yet to be taken on these cases and communicated to affected people.

Provide training on harvesting, handling and disinfection of targeted crops

This training was attended by one hundred and ninety-four (194) maize crop farmers comprising 96 females and 98 males. Six (6) of the farmers could however not attend the training sessions due to various reasons. The purpose of the training was to improve the skills of the farmers on how to effectively reduce post-harvest losses, improve on storage of food and thus, improve quality grain for use by consumers. They were taken through the appropriate chemicals to use for the storage of their grains and the use of improved storage structures and facilities like improved poly-sacks for the storage of various agricultural products. The training was intensive with practical illustrations and pictorial presentations on the dos and don’ts of maize and soybeans cultivation to remove or reduce mycotoxins/aflatoxins diseases to insignificant levels.

The farmers expressed happiness about the new and improved storage methods they learnt and promised to put to practice the new knowledge acquired. Project officers made follow up visits to farmers and were happy to see them implementing the new storage methods learnt.

The use of compost has become necessary because most soils are poor in organic matter and nutrients and unable to support plant growth. The loss of soil fertility is caused by bush burning, continuous cropping, overgrazing and erosion. Farmers thus resort to the use of inorganic fertilizers to boost their crop productivity. However, the continuous increase in fertilizer prices increases the farmers cost of production. To reduce this problem, farmers need to consider the use of compost which can be produced by the farmers using locally available decomposable materials.

Composting is one of the sustainable ways of improving soil fertility and increasing crop yield. This is because it leaves no harmful residues in the soil and improves the soil structure. Many farmers unconsciously produce some organic mature from their animal droppings and organic waste from their homes. However, this is not done in large quantities that can reduce their use of inorganic fertilizers. Thus, the intervention of ADDRO in supporting farmers to produce compost to fertilize their farms has been embraced by all participating farmers.

The farmers were taken through the various methods of compost making such as the pile method, which is good during the rainy seasons, the pit method which is good all year round and the ‘zai’ method which is almost all year round. Farmers were as well taken through the importance of compost to the soil. They were taught that the use of compost improves water intake and root penetration, and improves the resistance of plants to pests and diseases.

Participants were then taken through by extension officers with support from ADDRO field officers to prepare compost using the pit method since the farmers considered that method as the cheapest with easily available materials.

Fig 8: Farmers taken through how to make compost using the pit method

Organize experience sharing workshop for farmers

The purpose of this activity was to create an opportunity for farmers to learn from each other’s successes and challenges in order to assist in the adoption of improved practices. This was against the background that farmers do not all accept and adopt innovations and improved technologies at the same rate and time. While some will adopt early, some will wait to see the result from the early adopters before using the innovation or technology. Sharing experiences on the successes and challenges of the improved practices is one of the strategies for facilitating adoption. During the discussions, farmers shared with one another some best farming practices that have helped them to get better crop yields. Examples of the best farming practices identified were burying method of fertilizer application, proper weed control, early planting and harvesting at the proper time. The farmers generally were of the view that the YARA Actyva fertilizer supplied by ADDRO was very good and effective in maize cultivation and asked for this brand for the subsequent years. The participants were made of ninety-three (93) males and ninety (90) females.

Organize sensitization on bush fire prevention and controlled burning

This training was organized in the form of community meetings in which the two hundred (200) maize crop farmers were expected to participate. However, considering the interactive nature of the meetings, some interested community members who were not members of our farmer groups took part in the sensitization sessions. In all, two hundred and fifty-nine (259) participants took part comprising one hundred and thirty-one (131) males and one hundred and twenty-eight (128) females participated in the sensitization meetings. The sensitization sessions were facilitated by ADDRO staff with support from Extension officers. The topics for discussions included causes of bush fires, effects of bush fires, prevention of bush fires and how to control fire outbreaks. In some of the areas, community chiefs admonished community members to desist from burning the bushes and farmlands before cultivation. They further added that where it is necessary to burn, they should adopt controlled burning to avoid the spread of fire.

Fig 9: Farmers undergoing bush fire sensitization training

Demonstration farms field days

During the farming season, four demonstration farms were set up in three of the project implementation offices; two in ANWOC, one each in SAWDC and BACH project areas. Field days were held in each of the demonstration farms for the farmers to share ideas. The essence of these field days were to bring the beneficiary farmers together to share ideas on the new and improved methods of farming they implemented within the farming season. The lands for the demonstration farms were provided by volunteer farmers and the beneficiary farmers for the year did the sowing and planting. Field officers together with the extension officers took farmers through the protocol adopted for the demonstration farms.

Each of the farms were one acre and divided into two equal parts; one half of the farm used for the high technology field and the other half used for the farmer practice field.

On the high technology field, all practices were recommended by the Agricultural Extension Officer and ADDRO field officers but hand-practiced by the farmers whereas on the farmer practice field, farmers were allowed to carry out all practices in the way they have been practicing.

Field officers regularly visited demonstration farms to ensure that farmers follow the various practices till maturity and subsequently harvesting.

On the whole, it was discovered that the high technology field practice produced more yield than the farmer practice and thus, farmers were admonished to adopt the good agricultural practices they have been taught. For instance, at harvest a five square meters (5m2) plot for each of the above treatments was sampled and cobs threshed and the weight of the grains taken for yield estimates. The table below shows the output from the field.

TREATMENT

5m * 5m plot

Maize cobs

5m * 5m plot maize grains (kg)

Estimation by acre (4,000m2)

Remarks

High Tech

96

5.5

8.8 maxi bags

Higher yield

Farmer Practice

80

4.4

6.4 maxi bags

Low yield

Fig 10: Farmers at the Gbere-Kpalsako demonstration farm on the field day shelling the maize

Participate in National Farmers’ Day Celebration

The National Farmers’ Day is a day set aside by the government of Ghana to celebrate and offer awards to hard working farmers. The event is celebrated on the first Friday of December each year. Thus, ADDRO being a major stakeholder in the agriculture sector in the Upper East Region contributes in marking the event by supporting the Ministry of Food and Agriculture (MOFA) in the four districts the food security programme operates to award hardworking farmers in the respective districts.

All programme staff participated in the celebration of the day in their respective districts. The Programme coordinator also participated in the regional event to mark the day.

Programme review meeting

All program staff met in the course of the period to review the activities carried out so far, share ideas on best practices and challenges encountered during the period. Project officers took turns to share their experiences on the activities carried out; some explained the strategies they adopted in implementing the activities in the midst of time constraints due to farmers’ engagements on their farms. Some of the strategies include; scheduling of meetings early in the mornings before farmers leave for their farms and scheduling of two meetings at the same time with each officer attending to each meeting rather than both attending a meeting at a time.

Project officers also shared some successes chalked from the field which could be replicated by other project officers in their communities.

There was also an annual review meeting held for all programs staff to review the program activities for the year. Program officers presented on their program activities implemented for the year, successes, and challenges encountered and the solutions proposed. There was an open forum session for participants to either ask questions or share experiences.

FIELD MONITORING

Field monitoring forms a major strategy in the implementation of the program since it helps track performance of the program indicators. It was carried out at different levels; the management level and the field level. During the period under review, the new program coordinator undertook a day monitoring/familiarization visits to each of the project offices to acquaint himself with happenings in the respective offices as well as solicit their views on possible proposals that can be implemented to make the program more effective.

Program coordinator followed up on monitoring visits during the promotion meetings with community members to introduce the concept of SwE.

The Monitoring and Evaluation officer visited project centres to collect data for period one. These data is based on programme indicators such as number of communities selected, number of beneficiaries selected for support in 2016 among others. The M&E officer also visited the programme centres to train staff and enumerators to collect baseline data on 2016 beneficiaries.

Other management staff including the Head of Programs, Accounts officer and the Executive Director also conducted field visits to various project locations to assess the compliance with the program strategy and the use of program inputs by the project officers and the participants. This was to ensure that the program inputs and resources are used correctly for the intended purposes. Management staff monitoring was also to provide supportive supervision to the field staff and validate data and reports received from the field

Field officers monitor program participants’ adoption of good agricultural practices that they have been taught by regularly visiting them both at home and on their farms. These visits serve as opportunities to field officers to offer advice on how to increase their efficiency, and thus, their income levels. The specific areas monitored for the period were the recoveries on micro-credit and the input support, and the animal farmers, preparations of farmers for the next farming season and the selection of new farmers for the current season.

The interactions with beneficiaries during these meetings reveals that the beneficiaries are satisfied with the interventions they get from ADDRO and are appealing for an increase in the support.

Monitoring of programme activities was two-fold; regular visits by field staff to the communities to ensure that implemented activities are yielding results and meeting programme objectives and programme coordinator visiting field to assess the progress of implemented activities at the field level. Monitoring of project activities at the field level was carried out by project officers. Beneficiaries of the farm inputs (maize farmers) were visited to assess the performance of the crops at field, micro-credit beneficiaries visited regularly to see the progress of their businesses, processors to assess their progress and animals beneficiaries closely monitored to be sure farmers were practicing the skills acquired during the training sessions. Programme coordinator also paid regular visits to some communities to assess the extent to which programme staff have implemented activities. Programme coordinator closely followed the various activities carried out during the demonstration farming. These regular visits to the demonstration farm activities were to ensure that the field staff and extension officers followed the protocol designed for the farm demonstrations.

Visits were also made to some training activities of the programme to support the field staff in carrying out the trainings.

Per the findings made during these regular monitoring visits, it is hoped that the programme will achieve its objectives set for the year 2016.

CHALLENGES & RECOMMENDATIONS

Implementation Challenges

Proposed Solutions

The rains did not start in good time, thus slowed agricultural activities

Farmers were advised to consider planting short maturing varieties

The delay in release of funds has affected program activity implementation

In future funds to ADDRO should be released on time to ensure timely and effective implementation of activities

Heavy rainfall during the period thereby affecting programme meetings and the fear that the heavy rains could result in poor harvest

Programme meetings such as trainings should be done early before the rains set in

The period has been hectic and tiresome since they had to implement both period one and two activities within period two due to late receipt of funds

Funds should be released on time to ensure timely execution of activities

Intensify monitoring of various defaulters and writing them reminder letters

PROGRAM PARTICIPANTS

Farmers group: The activity is to build the capacity of farmers to produce more food to feed their families and generate income for other financial needs of their families such as education, health and social needs. The training is to increase farmers’ capacity to produce more food

Farmers in Animal rearing: The purpose of this activity is to assist targeted participants acquire breeding stock of small ruminants to establish livestock farms as alternative livelihood to crop farmers –

Agro-Processors group: This activity is to facilitate the increase in income of micro entrepreneurs by increasing their production level and improving the quality of finished products while reducing the cost of production. –

Micro credit group: The provision of micro credit to productive groups is to income generation in households.

HUMAN INTEREST STORIES

MOFA lauds ADDRO for great contribution

The activities of ADDRO is not only acknowledged by program beneficiaries, but highly appreciated by key collaborators like the Ministry of Food and Agriculture (MOFA). During the program staff capacity training workshop held recently in Bolgatanga, the facilitator on Good Agricultural Practices, Mr, Zimmi Alhassan, who is the deputy regional extension officer, acknowledged the contribution of ADDRO to maize production in the region. He said ‘the training on good agricultural practices to the farmers in your operational area especially in Binaba area coupled with the input support from ADDRO has helped increase maize production in such areas’. He further commended the ADDRO Community Agricultural Extension Volunteers model which to him has contributed tremendously in the knowledge base of farmers on good practices since the volunteers are readily available at the community to offer support to the farmers.

Fig 11 Mr Zimmi Alhassan facilitating during training workshop

Women farmers now own more animals

Mrs Akugri Mmalebna hails from Boya-Kpalsako, a suburb of the Bawku West District. She is a beneficiary of the ADDRO small ruminant support programme. During vaccination and recovery of offsprings to pass on to new beneficiaries, Mrs Akugri was full of praise for ADDRO and its partners for their support which now makes her a responsible mother. According to Mrs Akugri before she was enrolled onto the programme she could not feed herself and her children properly but after the intervention three years ago, she can now boast of seven animals of her own which she sells some to provide some basic needs for the family. She indicated that she recently sold one animal to buy chemical fertilizer to apply on her maize farm. She even added that the animal droppings are used as manure to fertilize her farm. According to Mrs Akugri but for this intervention “I would have been nobody in this community but now because I can feed my children and buy school things for my children, people now give me respect”. She added that “May the God that sees us and we don’t see him, bless ADDRO and the white people very much so that they continue to get enough and support we the poor”.

Women’s income levels improving rapidly

Low incomes amongst rural women in Bawku West District of the Upper East Region have become a real challenge. This is due mainly to low literacy levels or lack of education of such women together with the fact that access to funds for income generating activities are not easily found due to high interest rates offered by the financial institutions. As a result, most of these rural women in the district are housewives who are unable to provide their own basic needs and so depend largely on their poor husbands who are sometimes not able to provide such needs due to similar reasons enumerated above.

In order to address this anomaly, the Anglican Diocesan Development and Relief Organization (ADDRO) intervened with its agro-processing support package under the food security and livelihood support program. In 2014, fifty women benefited from this support package. It was to enable them increase the quality of processed food products as well as reduce the drudgery involved in such businesses through the provision of improved processing equipment and business management skills training. This would eventually lead to an increase in women farmers’ income through the sale of processed food products.

Through this intervention, Mrs. Anamzei Abambisida, a 41-year old woman with six children, with no educational background from Kpantarigu was amongst the 2014 beneficiaries of this program. She received two bags of sheanuts. By the middle of 2016, she had made significant gains from the processing of sheabutter and decided to go into provision sales. Thus, she now sells provisions on table which is worth One Thousand Five Hundred Ghana Cedis (GH₵1,500.00) which is 650% more than her start-up capital of Two Hundred Ghana Cedis (GH₵200.00) which was the cost of the two bags of sheanuts in 2014. With these gains she is now able to purchase foodstuff to supplement what she gets from her farming activities. She was also able register for the national health insurance scheme and renew for herself and children on yearly basis. She was able to pay school fees for two of her children at the senior high school together with other needs of her six children. In her own words, “This would have eluded me but for the intervention of ADDRO and its partners.”

Fig 12 Picture of Madam Anamzei Abambisida

3.0 INTEGRATED COMMUNITY-BASED HEATH PROGRAM

3.1 INTRODUCTION

The project title is Integrated Community-Based Health (ICBHP). The project aims at providing quality primary health care especially to children under five years, pregnant women and care givers. The project uses ICCM strategy. The iCCM is a strategy that uses trained, supervised and supported community based agents (CBAs) to provide diagnostics and treatment and SBCC activities for illnesses such as malaria, diarrhoea and pneumonia for sick children of families with difficult access to case management at health facilities. These three conditions are known to be the leading cause of deaths in children under five years of age. This project (iCCM) is consistent with practices recommended by Ghana Health Service (GHS) and other international health agencies such as WHO.

These CBAs are provided with treatment manual that guides them to decide how and when to treat children with cases of malaria, diarrhoea and acute respiratory infections (Pneumonia) in children aged 2months to 59months. These manuals also provides guide on how to recognize which children must be referred for treatment by health workers and how to do the referral using a referral form. The CBAs also give health education on these conditions to community members, manage drugs and supplies and report iCCM activities to ADDRO regional Coordinators and GHS staff.

Regional Coordinators in partnership with GHS sub districts staff held review meetings with CBAs to brief them on diarrhoea, pneumonia and malaria issues. Also to help CBAs cover distant households for health education on malaria, diarrhoea, pneumonia and maternal issues, bicycles were bought for CBAs to facilitate their movement for this education.

As part of its efforts in ensuring that children under five have access to quality health care at the community level to reduce the incidence of malaria and child mortality, ADDRO regional Coordinators in partnership with Ghana Health Service (GHS) supervised the work of CBAs in all the sub districts across the six regions.

CBAs continued with their routine health education and treatment of children under five years of age suffering from malaria, diarrhoea, and pneumonia .Information on these three conditions were collected from CBAs and entered in to the District Health Information Management System (DHIMS2) for policy decision at the national level.

The MCH program operates in six (6) regions but seven (7) sub- Districts in Ghana. The operational Regions and Sub-districts are as follows:

Bawku West and Builsa North in Upper East Region

Karaga in the Northern Region

Nadowli in the Upper West Region

Bosome Freho in the Ashanti Region

Akwapim South in the Eastern Region and

SefwiWiawso in the Western Region of Ghana.

ADDRO’s interventions are being implemented in one Health Sub-District in each of these selected districts mentioned above. A Health Sub-District (SD) is a cluster/number of communities demarcated by GHS for health service provision.

Program goal: To contribute to reduction of communicable diseases including; malaria, pneumonia, diarrhoea and their related morbidity and mortality among children under five years, and to promote appropriate health seeking behaviour among mothers in rural communities.

Program purpose: To provide information, skills, knowledge and tools to local communities and stakeholders to work towards prevention and control of these communicable diseases.

Thus ADDRO has adopted the integrated Community Case Management (iCCM), social and behaviour change (SBCC) strategies to address the following specific objectives of the health program:

3.2.2 Planned Activity Not Carried Out and Reason

ADDRO could not carry out these trainings because of the preparation for the Post Distribution Check-Ups (PDCU) in Northern Region, Ghana. The schedule period for these trainings and PDCU in Northern Region was so closed that, ADDRO thought it wise postponing the training to have enough time to prepare for the PDCU. Also due to the time period between these trainings and the mid-term to be carried out, ADDRO has planned to carry out these trainings after the mid-term evaluation. This will help us better understand training needs and tailor training towards those areas.

2.2.3 Details of Activities Carried Out.

Project Mid-Term Evaluation

ADDRO had plans to conduct a mid-term evaluation of the heath project before the end of 2016. With this, ADDRO solicited for expression of interest (EOI) from various consultants to apply for the task. Two proposals were received and reviewed by both ADDRO and Episcopal Relief & Development. Nevertheless, the exercise could not take place during the period.

Considering the fact that the first phase of the project comes to an end in 2017, ADDRO has considered carrying out an end-of-term evaluation instead of mid-term. ADDRO intend discussing this with its partners, Episcopal Relief &Development for consideration of this change of idea. As at the time of writing this report, no agreement has yet been reached.

2.2.4 Social and Behaviour Change Communication (SBCC) activities

A series of Social and behaviour Change Communication (SBCC) activities (sensitization/ durbars) on malaria, diarrhoea, Acute respiratory Infection (ARI), child nutrition and the importance of ANC and CWC attendance were carried out in various communities in all ADDRO’s seven sub districts. The main focus of these SBCC activities was to raise the awareness on the prevention of these conditions as well as the treatment options available at the community level- seeking care from CBAs. These SBCC activities also aim at demystifying cultural practices that may influence health seeking behaviour negatively and to influence health seeking behaviour of community members positively. In these SBCC activities, small groups are organized for sensitization activities from one community to another. The discussions are participatory using SBCC strategies to help change certain health practices of community members. These sensitization sessions are facilitated by GHS staff and supported by ADDRO regional Coordinators.

On malaria, facilitators guide participants to discuss cause, predisposing factors to getting the disease, signs and symptoms, prevention and treatment. On the preventive measure, emphases are played on community members sleeping under LLINs every night throughout the year. Environmental cleanliness is also encouraged to avoid it serving as breeding places for mosquitoes and contraction of malaria.

On diarrhoea, discussions are centred on the causes, signs and symptoms, prevention and treatment. Personal and environmental cleanliness such as keeping children’s finger nails short, thorough hand washing with soap and water and having pit latrines or burying human excreta as effective ways of preventing diarrhoea are encouraged.

On ARI, discussions are also focused on causes, signs and symptoms, prevention and treatment. Mothers/caregivers are encouraged not to expose the children to the hazards of the weather.

Education is also given on the importance of attending ANC, CWC and basic child nutrition including exclusive breast feeding. Mothers are also encouraged to complete all immunization schedules for their children to prevent diseases such as pneumonia, measles, and yellow fever just to mention a few.

The table below summaries the sensitization activities in the seven sub districts Summary of sensitization activities.

№

Region

Sub district

Total no of communities

No of communities

sensitized

No of sessions

held

Attendance

Male

Female

Total

1

Upper East

Chuchuliga

18

9

9

79

395

474

2

Upper East

Sapeliga

25

12

12

49

255

304

3

Northern

Zandua

20

9

9

341

412

753

4

Upper West

Nanvile

12

7

7

324

375

699

5

Ashanti

Bosome Freho

12

7

7

154

251

405

6

Eastern

Parkro

25

12

12

117

361

478

7

Western

Anyinabirim

27

12

12

415

435

850

TOTAL

139

68

68

1,479

2,484

3,963

2.2.5 Monthly Group Meeting With Caregivers/Mothers

ADDRO regional coordinators continued to hold series of sensitization sessions with mothers/caregivers. These meetings were held at various communities and health Centres on their CWC and ANC days. At these meetings, mothers were educated on causes, prevention and treatment of diarrhoea, malaria, pneumonia especially in children under five years as well as the need to seek early and appropriate medical care for these conditions. Mothers were also encouraged to take immunization seriously as it prevent children from other diseases and also beneficial to children’s growth and development. The importance of ANC attendance and skilled delivery was also discussed. The table below contain summary of various meetings with mothers/care givers in all the sub districts.

Summary of Monthly Group Meeting with Mothers/care givers.

No

Region

Sub district

No of sessions

Attendance

M

F

Total

1

Upper East

Chuchuliga

15

0

357

357

2

Upper East

Sapeliga

17

4

428

432

3

Northern

Zandua

11

0

802

802

4

Upper West

Nanvile

10

0

174

174

5

Ashanti

Bosome Freho

13

0

504

504

6

Eastern

Parkro

17

72

392

464

7

Western

Anyinabirim

17

16

568

584

100

92

3,225

3,317

2.2.6 ICCM ACTIVITY BY CBAs.

During the quarter, CBAs continued with their house holds visit, treatment and giving of health education on malaria, pneumonia, diarrhoea and basic hygiene practices, example hand washing with soap.

The table below shows the performance of iCCM activities by CBAs in all ADDRO seven sub districts during the quarter under review.

Table showing CBAs Activities

ACTIVITY

NUMBER

# of children brought to CBA to be checked for illness.

7,824

# of children with fever

6,045

# of children with fever tested with RDTs

4,265

# of children tested positive

3,668

# of children tested negative

597

# of RDTs positive cases given A/A

3,668

# of children treated without testing with RDT

1,812

# of children seen with fast breathing

1,644

# of sick children with fast breathing( pneumonia) given Amoxicillin

1,657

# of children seen with diarrhoea

1,487

# of sick children with diarrhoea given ORS

1,482

# of sick children with diarrhoea given Zinc

1,482

# of children referred

59

# of community sensitization meetings

117

# of monthly meetings with mothers/care givers

100

2.2.7 Collaborative Meetings

Program Health Coordinator attended a regional Health performance review meeting August 24, 2016 in Upper East region, Bolgatanga. The review meeting was attended by all districts directors of health services, Non-Governmental Organizations/Civil Society Organization (NGO/CSOs) in health and other key stakeholders such as the Regional Coordinating Council. In his welcome address the regional director of health acknowledged the contribution of all NGO/CSOs to the achievement of health goals in the region. On iCCM, ADDRO was commended for its contribution towards the achievement of iCCM targets in the two sub-districts in Upper East, Chuchuliga and Sapeliga.

At the regional level, ADDRO Regional coordinators continued to have collaborative meetings with GHS to plan with them and agree on iCCM implementation schedules at the communities. This idea was to involve staff of GHS in planning our iCCM activities at the communities. Staffs involved in these meetings were the district malaria/iCCM focal persons, sub district leaders and sub Community Health Officers (CHOs), who supervises CBAs at the communities.

2.2.8 Integration of iCCM DATA into DHMIS2

The District Health Management Information system (DHMIS2) is software that supports the capture of data linked to any level in the health sector.

All Regional Coordinators continued to work in collaboration with Ghana Health Service (GHS) to facilitate entry of iCCM data collected from CBAs into the DHMIS. Data collected from CBAs are summarized into two templates. A copy of this template is given to GHS and one for ADDRO use. On the agreed day for the data entry, ADDRO Regional Coordinator then sends his copy to the District Health Information Officer to validate the data before it is entered into the DHMIS2. This exercise is done monthly. Whilst entering these data at the various districts, the information is also seen at the various levels, district, regional and national.

2.2.9 Procurement of Bicycles for CBAs

Households visits for health education and treatment of children is key role played by CBAs in their communities. Some of these households are a bit far making it difficult for CBAs to reach. In order to facilitate the CBAs movement for this health education and treatment of children under five years, 130 bicycles were bought for CBAs in the southern sector, Ashanti, Eastern and Western regions to facilitate their movement for this exercise. CBAs in the Northern sector, Northern, Upper East and Upper West had their bicycles last year, 2015

These bicycles have been distributed to the CBAs through respective Districts Health Administration.

2.2.10 Review Meeting with CBAs

ADDRO regional coordinators in the three Northern regions held separate review meeting with CBAs in their respective regions. This became necessary following the introduction of the Seasonal Malaria Chemotherapy (SMC) in most of the regions in Ghana where ADDRO works with these CBAs. SMC as the name suggest is a seasonal malaria preventive treatment given to children below the ages of five years. This was done for three successive months during the malaria peak season (July-September, 2016) to prevent children from getting malaria. During this period, children less than five years could only be treated with Artemether Lumefantrine but not with Artesunate Amodiaquine. During this three months period, CBAs recorded significant decline on the number of children treated though peak season for malaria. The reason was because CBAs had Artesunate Amodiaquine but not Artemether Lumefantrine. However, malaria treatment with ACT or A/A was permissible after the three months period.

ADDRO staff having been invited to take part in this meeting organized by GHS on July 2016, organized review meetings to re orient its CBAs on the SMC to ensure that the necessary quality assurance measure are followed. Though some of CBAs took part in the exercise, most of ADDRO’s CBAs did not take part, hence the need for the orientation. These review meetings also afforded ADDRO the opportunities to demystify any wrong perception that CBAs may have about the SMC and iCCM. Regional Coordinators reviewed the data collection tools with CBAs during this meeting. Though few CBAs did not turn up, their partners were around for the training.

2.2.11 Consultative Meeting with DHA

ADDRO/Episcopal Relief & Development in collaboration with GHS with support from AMF carried out mass LLINs distribution in Greater Accra, Northern and Upper West regions in 2016. Having successfully distributed these LLINs to 43 selected districts in these regions, ADDRO /Episcopal Relief & Development/NetsforLife® strategy requires a follow-up of each net that reached the beneficiaries. This strategy involves:

Monthly Sensitization of households on malaria, diarrhoea and ARI issues.

Quarterly follow-up on LLINs and data collection on condition and usage of the LLINs

In view of this, ADDRO held consultative meeting with District Health Administration Teams in all the three regions to brief them on this strategy and the intention of using their existing community volunteers who could read and write for the exercise. They were also requested to assist ADDRO recruit to replace volunteers who could not read and write as the tasks requires some level of reading and writing. These meetings were held on different dates, Greater Accra was October18 to November 4, 2016, Upper West November 7 to 14, 2016 and Northern region November 31 to 3rd December, 2016.

2.2.12 Recruitment of Sub District Volunteer Supervisors.

ADDRO/Episcopal Relief & Development initially agreed to use Sub District Supervisors for the Post Distribution Check Ups (PDCU) by AMF to supervise volunteers for the NetsforLife® strategy. However, during the consultative meeting with various DHA especially Accra and Upper West, they disagreed with this idea. The reasons for their disagreement were that:

GHS implement, supervises and are responsible for all outcomes (positive and negative) of health programs in Ghana.

The strategy, though not pervasive, involves giving of health messages on malaria, diarrhoea and pneumonia which the SDS have no adequate knowledge and capacity to supervise the volunteers

GHS recruited and trained these volunteers and responsible for their supervision in all health programs.

GHS has the capacity to train and guide these volunteers on the health messaging

GHS will not allow any other persons to supervise their (GHS) volunteers

ADDRO discussed these challenges from the field with Episcopal Relief & Development which both partners agreed to allow the GHS train and supervise the volunteers for the follow up strategy.

ADDRO got back to GHS with this new idea and for their support in getting these supervisors for the exercise. GHS have provided ADDRO with all the SDS for the three regions. The details are given in the table below:

Region

Number of SDS

Northern

95

Upper West

81

Greater Accra

63

TOTAL

239

2.2.13 Training of Sub District Volunteer Supervisors (SDVS)

The main roles of SDVS who are GHS staff involve recruitment and training, effective monitoring and supervision of community volunteers for the LLINs follow-up and health messaging on malaria, diarrhoea and pneumonia in all beneficiary households.

ADDRO organized a one-day Training of Trainers (TOT) for all the SDVS who were to organize cascade trainings for the volunteers in their respective sub districts.

ADDRO developed a training guide meant to be used for the training of both SDVS and volunteers involved in the monthly sensitization and quarterly data collection throughout the program. The sub district volunteer supervisors will in turn use the guides to train the volunteers for the follow-up and health messaging.

ADDRO headquarters staff organized a one-day Training of Trainers (TOT) on the follow-up strategy including use of the data collection tool and health messages for the ADDRO regional staff.

The training of the SDVS was facilitated by both ADDRO regional and GHS staff.

GHS facilitators (mostly malaria focal persons) trained SDVS on causes, signs and symptoms, prevention and home management of Acute Respiratory infection (ARI) or suspected Pneumonia, Diarrhoea and uncomplicated Malaria. ADDRO regional staff on the other hand took the SDVS through on the use of the data collection tool (filling the monthly activity form), roles and responsibilities of SDVS and Volunteers.

The one-day training was carried out using the following methods:

Pre- and Post-Test

Presentations and Discussions

Practice filling data collection forms using scenarios

Details of attendance and training are provided in the table below:

REGION

TOTAL SDVS

NUMBER TRAINED

REMAINING TO BE TRAINED

Upper West

81

81

0

Northern

95

47

48

2.2.14 Recruitment of community volunteers

Recruitment of community volunteers for the follow up strategy for Northern and Upper West regions is completed, with a total of 5,076 community volunteers for these two regions made up of 1,511 for Upper West and 3,565 for Northern region.

In Greater Accra region, volunteers declined due to low incentive (GHC 20 per quarter). Volunteers’ proposal was between GHC 150 to 200 every month. The explanation was that due to the urban nature of the region, GHS usually hire and pay volunteers any time there was a campaign. GHS further explained that during the LLINs mass distribution in July 2016, volunteers were offered GHC 20 per day; and even with that, most of them refused to work because the amount was not enough. GHS had to rely on their staff and community members who had just completed Junior and Senior School graduates who were home at the time.

Based on ADDRO’s discussion with Episcopal Relief & Development on this issue, both have resolved to do the follow up in two out of the 12 districts in this region. The reason is that since the amount may not be enough to cover the entire region, the amount for volunteers on the other districts could be used to raise volunteers’ allowances in these two districts to do the follow up.

ADDRO wished to complete the PDCU in January 2017 in this region and work with GHS to recruit and train volunteers in the two districts to start the follow up.

2.2.15 Replacement and Training of CBAs

During the period under review, we lost four (4) CBAs, one in Chuchuliga, one in Nadowli and two from Sapeliga sub district. Two CBAs in Bosomefreho in the Ashanti region also travelled out of their communities. ADDRO worked with GHS in these sub districts and has replaced all these CBAs. Though ADDRO/GHS have organized short training for these new CBAs and paired them with the old CBAs, permanent training will be done in 2017. ADDRO/GHS continue to support these CBAs during routine field visits until a full training is organized.

1.6 Split of Sub district into two

The Anyinabrim subdistrict in the Western region had been divided into two sub districts by GHS. This split became necessary due to the large size of the sub district. This will help in effective and efficient administration of health services and monitoring. The new sub district is Abrabra. This implies that an additional sub district is added giving the total sub districts where ADDRO works to be eight. The 54 CBAs formerly in the Anyinabirim, has also been split with 20 CBAs in Anyinabrim and the remaining 34 in Abrabra.

3. FIELD MONITORING

ADDRO Headquarters staff could not carry out monitoring visit to its communities during this third quarter. However ADDRO Regional Coordinators continued with their routine monthly monitoring visits to their respective communities to monitor CBAs work, observe and support them where necessary. This routine visits at times were carried out with GHS Supervisors. This creates an opportunity for ADDRO regional staff and GHS to collect and validate data, and to identify any training needs of CBAs.

CHALLENGES & RECOMMENDATIONS

One major challenge reported was lack of transport at the facilities for referred clients. Some CBAs reported that when children with severe illness and women in labour are referred, they do not get means of transport or either arrives there late in a worse condition. Some women had to be delivered by Traditional Birth Attendance (TBAs) at home which is not encouraged. Few Community Health Planning and Services (CHPS) compounds located in these hard-to-reach communities had no transport for such emergency referrals. This challenge was reported in three sub districts, Zandua, Builsa North and Nandowli in Northern, Upper East and Upper West Regions respectively.

Another challenge has to do with CBAs treating malaria in children without testing as a result of RDTs shortages. ADDRO has engaged GHS at the district and regional levels to get this issue resolved.

Other challenge was the temporary suspension of the use of Artesunate Amodiaquine and non-availability of Artemether Lumefantrine for use by CBAs to treat children under five years suffering from malaria due to the inception of seasonal malaria chemoprevention (SMC) therapy. ADDRO staff however encouraged CBAs to do more SBCC activities and refer all malaria positive diagnosed cases to the nearest Health facilities.

ADDRO lost two of its CBAs, one from Builsa North District and the other Bawku West District. ADDRO Regional Coordinators in these districts represented the organization during their burials to share sympathies with the bereaved families. However, ADDRO in collaboration with GHS have recruited one CBA to replace the late CBA in the Builsa North. Equally, ADDRO is working with GHS to recruit one for the Bawku West. This CBA has been given some level of training to start work.

PROGRAM PARTICIPANTS

ADDRO’s main partner in the iCCM program is Ghana Health Service (GHS). They develop appropriate iCCM strategies and provide technical guidelines to the program. Also staff of GHS at the district and sub district levels continuously monitors and supervise CBAs on the iCCM program. They also ensure that data on iCCM activities from CBAs are entered into the District Health Management Information System (DHMIS2) for policy decision by Ministry of Health (MOH), which GHS is responsible to. GHS staff at these levels trains the CBAs and facilitate in all ADDRO iCCM activities at the communities.

HUMAN INTEREST STORY

Fig 15 Madam Vida in her shop at Chuchuliga in the Upper East Region

Madam Vida Abaachab, is a 42-year old trader at the Chuchuliga market in the Builsa North District. Madam Vida trades in foodstuffs such as maize, rice, millet, beans and groundnuts. These produce are always bought in small quantities due to her small income level.

She has been looking for an opportunity to expand her business which never came until April 2016 when she heard of a program known as Savings with Education being implemented by the Anglican Diocesan Development and Relief Organization (ADDRO) in her community, Tiedembilsi. This was what she had to say:

A colleague told me about this Savings with Education group she has joined which is helpful. When I asked of the benefits of joining the group, she told me that group members are engaged in weekly savings so that when the money grows to an appreciable level they could share their savings or lend money out to members. Having thought of saving money to expand my business, I quickly joined Adefitali savings group. When the time for loan disbursement came, I requested for a loan of Two Hundred Ghana Cedis (GH¢200.00) to buy more cereals to expand my business and also to pay back the loan in three (3) months’ time. The loan was given to me without difficulty. My worry of getting money to expand the business is over and I also benefit from health talks during these weekly meetings. I am grateful to ADDRO for this initiative, God bless them.

3.0 HIV/AIDS

3.1 INTRODUCTION

There are an estimated 280,000 people living with HIV/AIDS in Ghana, with a national HIV prevalence rate of 2.1% (2011 HIV sentinel survey). Evidence suggests a stable trend of HIV infection in the general population yet HIV infection is on the increase within. Studies also revealed the low uptake of VCT among the populace and commercial sex workers and the majority of those who tested positive were unaware of their status.

Generally, stigma and discrimination towards HIV/AIDS is recognized as a major obstacle to HIV prevention, treatment, care, and support. This poses challenges to preventing further infections, alleviating the impact, and providing adequate care, support, and treatment.

The HIV/AIDS prevalence rate in the Upper East Region has seen a remarkable drop from 2.4 per cent in 2010, 1.5 per cent in 2011 and 1.37% in 2012. However, Navrongo District maintained a consistency rate of 2.2 per cent in 2010 and 2011, whiles the Bolgatanga Municipality recorded 3.8 per cent in 2010 and 2.2 per cent 2011. These records, though of significant benefit, leaves much to be desired.

Within the reporting period, ADDRO worked within the religious structures (churches and mosques) to ensure a reduction of new infections in various communities.

The project aims to ensure increases in the uptake of HIV Testing and counselling (HTC) through religious congregations and mobile outreaches among others. Key to this project is an effective stigma reduction strategy as indicated in its objectives below. Working at reducing stigma has the potential of reducing the spread of HIV and mortality due to HIV. The support of peer educators among other groups in HIV/AIDS outreach and clinical activities has the potential to reduce the negative effects of stigma. Peer education can also effectively reduce stigma, promote healthy sex behaviours, provide role models, and create hope among the populace.

3.2 OBJECTIVES

To promote safer sexual practices among 30 religious congregations in three Districts in the Upper East Region by the end of June, 2016

To promote the uptake of HIV testing and counselling services among 30 religious congregations in three Districts by the end of June 2016

To sensitize18,900 youth and adults among 30 congregation in three districts on HIV/AIDs stigma reduction and discrimination practices against PLHIV by end of June 2016

Train clergy and church leaders on HTC including couple testing and counselling

Conduct Mobile outreach on HTC

4.0 CONCLUSION

Overall, ADDRO’s work throughout 2016 was largely successful. This was achieved through participatory planning, effective implementation, monitoring and evaluation.

Lessons learned from implementation of our activities in 2016 would go a long way to help ADDRO improve upon effectiveness of our strategies in the coming years. Going forward, we shall continue to step up our fundraising efforts in order to secure more sustainable funding for the organisation.

Let me take this opportunity to express my gratitude to the Almighty God, staff, Board members, partners and even volunteers for their dedication and support, which enabled the organization to achieve its objectives.

Once again, I want to render our sincere thanks to you all for your strategic support to the course of ADDRO towards the realisation of our desired goals.

Wishing you Merry Christmas and a Prosperous New Year in advance!

With kind regards and blessings.

Rt. Rev. Dr. Jacob Ayeebo

Executive Director.

December, 2016

Fig 16 LLINS distribution in one of the communities in Upper East Region

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